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The more forgiving amongst us may feel some genuine pity for Health and Human Services Secretary Kathleen Sebelius. On one hand, President Barack Obama loaded her department with the mammoth task of writing up the thousands of rules and regulations that will constitute the real weight of ObamaCare. On the other, he charged Secretary Sebelius with the even more onerous duty of convincing a (rightfully) skeptical American public that the new 2,801 page health care reform law represented a landmark achievement that would benefit all citizens. So far, this hasn't gone so well.

The law remains unpopular to this day due to failure in the realms of principle, policy, constitutionality, and public relations. This lingering unpopularity has led to serious real-world consequences for the law itself. As Joshua Withrow noted before, a stunning majority of states have refused to set up their own state "exchanges," which are the basic machinery through which ObamaCare is meant to operate.

Unless these states undergo an inexplicable change of heart, this means that Secretary Sebelius's department will now take on the added responsibility of creating a majority of the state health insurance "exchanges." In fact, her department has so far only granted "conditional approval" to seventeen proposed state "exchanges," so the number may end up even higher than twenty-seven. It goes without saying that creating just one of these exchanges is not a cheap, simple, easy, or quick process.

Remember, the clock is ticking on ObamaCare's implementation. On October 1st of this year, citizens will supposedly be able to purchase health insurance through these "exchanges," with their coverage beginning on January 1st, 2014. Secretary Sebelius, in fear of this fast-approaching implementation deadline, has graciously (read: desperately) decided to extend or even outright waive the deadline for states to set up their own "exchanges."

This isn't the first time that Secretary Sebelius has postponed this particular deadline. Originally, states were meant to submit their proposals to her department on November 16th of last year. However, well aware that a large majority of states would not meet that deadline (or had any intentions of trying), she delayed it on November 9th to December 14th while demanding that those states that did intend to create an "exchange" must submit a brief "letter of intent" along those lines by the original deadline of November 16th.

This new deadline didn't work out so well, either. On November 15th, when Secretary Sebelius finally realized that those "letters of intent" probably weren't in the mail, she ditched that idea and admitted that the letters could be sent on December 14th, as well. However, she insisted that she would make a final decision on January 1st of this year regarding which states would be allowed to create their own "exchanges." Surely, this would be the final deadline.

As you might suspect, it didn't turn out to be the final deadline. On January 14th, Secretary Sebelius admitted that she would still accept proposals from states that desired to create their own "exchanges." In fact, she will now "waive or extend the deadline" for those states. Perhaps to preserve a shred of dignity, her department claims that proposals for "partnership exchanges" between states and the federal government must still be submitted by February 15th.

It's fair to ask whether Secretary Sebelius is "kicking the can down the road" on the issue of ObamaCare implementation. Well aware that her department is ill-prepared (if not completely incapable) of taking on the gargantuan burden of creating dozens of state "exchanges" by itself, she has continually pushed back this key deadline. Now, there is no true deadline, other than the planned starting date of October 1st.

Is there still time for her department to create these "exchanges?" Not if you were to ask Dan Mendelson, president of consulting firm Avalere Health.

TheWashington Postquoted Mendelson as saying that, "It would be very hard at this point to start from scratch. I’m not going to say it’s impossible, but it would be unlikely." To be fair, he was discussing recalcitrant states and not the Department of Health and Human Services, but that only makes it worse. A state only needs to construct a single exchange. Secretary Sebelius will have to build dozens. Also, keep in mind that Mr. Mendelson provided this opinion months ago on November 9th. The situation has only grown more dire for Secretary Sebelius since then, as so much precious time has elapsed.

Secretary Sebelius has a hard job. However, she is engaging in pure self-delusion if she believes that repeatedly pushing back these deadlines will cause the states resisting ObamaCare to flock under its banner in these final months. The longer she holds out baseless hope along these lines, the less time her department will have to slap together a pile of last-minute "exchanges."

As FreedomWorks’ Vice President of Health Care Policy Dean Clancy put it, "The wheels are coming off the bus, and the Administration is getting desperate." It's time for Secretary Sebelius to admit the obvious: a majority of states in the Union do not support ObamaCare and do not want to participate in it.

Daniel, we can only hope that the longer it goes and the more states refuse to comply, the better our chances at still destroying this useless bloated piece of legislation. We have to think 2014 Senate and try to sink the titanic.

With the King v. Burwell decision expected to drop in only a couple of weeks, many in the media are whipping themselves into a frenzy over the consequences of vanishing subsidies. Depending on who you believe, between 6 and 7 million people could be affected if the Supreme Court rules that words mean what they mean, and Republicans have proposed several plans to bridge these people gently away from ObamaCare.

The time is near: later this month the Supreme Court will issue its ruling on King v. Burwell. The case centers around the question of what the phrase “established by the state” means, and how it affects eligibility for subsidies.

In 2013, Jeb Bush made a comment critical of Republican efforts to defund ObamaCare, saying that we should instead let the law fall apart on its own. It was kind of an insensitive approach, given the number of lives that depend on a health care system that actually works, and I believe he was tactically misguided, but he was right about one thing: ObamaCare is falling apart, slowly but surely.

At the end of June, the U.S. Supreme Court will rule on a case – King v. Burwell – that could shake ObamaCare to its foundations. If the case goes the way of the plaintiffs – upholding the plain text of the Affordable Care Act as passed by Congress – the health insurance subsidies flowing to millions of Americans in states which did not opt into ObamaCare would cease. Congress will have no choice but to reopen President Obama’s signature law to address this legal difficulty. How our legislative branch handles the situation will have a profound impact on the prospects for free-market health care reforms in the future.

Congress is rapidly reaching a crossroads on ObamaCare. When the Supreme Court rules in a couple of weeks, there is a decent chance that the IRS’s insurance subsidies in 34 states will be officially ruled illegal and cease to operate. If that happens, politicians on both sides of the aisle are going to need to figure out what to do, because we will then be in a situation where ObamaCare is mandating that people buy insurance that they absolutely cannot afford.

Personal Freedom and Prosperity 109: Subsidiarity
In 1991, Pope John Paul II wrote in the Centesimus Annus that the Welfare State contradicts the principle of subsidiarity by usurping and relieving society of its responsibility to their neighbors and community. This “leads to a loss of human energies and an inordinate increase of public agencies which are dominated more by bureaucratic ways of thinking than by concern for serving their clients and which are accompanied by an enormous increase in spending.”

The 16 states with ObamaCare exchanges have each had access to hundreds of millions of dollars in grant money from the federal government to help establish a successful marketplace. And yet, many are finding themselves struggling with high deficits and low enrollment.

As the Supreme Court mulls over arguments in the King v. Burwell case that could unravel key portions of the president’s signature health care law, the Obama administration has adopted an attitude that is remarkably cavalier.

Arkansas' experiment with Medicaid expansion under ObamaCare is quickly becoming a train wreck for taxpayers. State officials have failed to determine that beneficiaries of the program are still eligible to participate in the government health insurance program, potentially wasting millions of dollars. Knowing how government operates, it is likely that Arkansas is not the only state to fail to do its due diligence.

It’s been difficult not to notice that a lot of states are having terrible experiences with their ObamaCare exchanges. In fact, a recent Washington Post article reports that “Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially.”